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by Tori Hudson, N.D.

More than ever before, women are entering menopause, educating themselves, asking their doctors questions, and requesting information about options for treatment.

No two women’s menopause transition is alike and women themselves, educators, and health care practitioners are experiencing the challenge of evaluating and managing each woman individually to achieve optimal results and optimal health.

Many women begin to experience an array of physical and mental emotional symptoms long before they meet the definition of menopause. These changes that occur over as much as several years usually from around age 40 to 51 are a transition period called “perimenopause”. A narrower definition is the transition period from regular to irregular menses. On average, the onset of perimenopause occurs around age 47 and the average duration is 4 to 5 years.

The symptoms of decreased hormone levels and perimenopause symptoms are varied, unpredictable and often go unrecognized as a perimenopause symptom. Due to not recognizing a problem as a perimenopause symptom, lack of precision in FSH testing , inadequate understanding of menopause on the part of both patient and health care practitioner, many women become dissatisfied with their health care.

The signs and symptoms of perimenopause include menstrual irregularities and changes in the amount of blood loss, hot flashes, night sweats, vaginal dryness and thinning, skin changes, fatigue, decreased libido, decrease in arousal and orgasmic response, mood swings, weight gain, joint paints, depression, anxiety, changes in memory and cognition, sleep disturbance, hair loss on head, hair growth and acne of face, heart palpitations, nausea, headaches, urinary tract infections, urinary incontinence, and the beginning stages of osteoporosis and heart disease.

The symptoms initially will vary from subtle and infrequent to overt and daily. Symptoms can be mild, moderate, or severe. Some women will have no significant menopausal symptoms except in the menstrual cycle and others will have symptoms that are progressive and problematic for years to come.

Perimenopause is a time of instability and unpredictability. Many things are changing other than estrogen and progesterone levels. Women’s hormone levels are changing not only in their total serum levels, but they are also changing in relationship to each other. Women are also aging which contributes to many of the changes like weight gain, changes in metabolic rate, and outlook on life. Factors such as age, stress, and body weight also begin to play a larger role in estrone production.

The two most significant changes associated with the perimenopause and continuing into the postmenopausal years are decreases in bone mineral content and changes in lipid profiles. Perimenopausal women should be screened to determine those who are at risk for osteoporosis and those who are at risk for premature cardiovascular disease. Adequate advice about diet, exercise, nutritional supplementation should be fundamental for all women. Individual assessments and recommendations about the use of either phytoestrogens, natural hormones, and/or conventional hormone replacement therapy, bisphosphonates, lipid lowering and antihypertensive medications need to be made for each woman based on her risk factors and needs and preferences.

Natural therapies are very well suited for the perimenopause patient. Conventional HRT is not the only option. Women who should not or do not want to take hormones may turn to herbal and nutritional therapies for managing their menopausal symptoms and risk factors. These natural therapies are increasingly popular and have a growing body of scientific evidence to support their efficacy. A 1998 report indicates that 42% of adults have tried alternative medicines. According to a survey in 1993 of 1,539 adults, one in three said they used at least one alternative therapy in the past year.

Phytoestrogens

Plants manufacture thousands of chemical compounds vital to the health and function of the plant. Those chemical compounds, generally known as micro-nutrients, are consumed in the diet by humans whenever the plants are eaten. One of these class of chemical compounds manufactured by plants are known as phytoestrogens. Over 300 plants contain phytoestrogen compounds. They comprise a large part of our diet, and our found in medicinal plants as well.

There are several sub classifications of phytoestrogens; the following partial list may be helpful:

Phytoestrogen   Plant source
Lignans   Vegetables, fruits, nuts, cereals, spices, seeds; especially flax seeds
Isoflavones   Spinach, fruits, clovers, peas, beans; especially soy
Flavones   Beans, green vegetables, fruits, nuts
Chalcones
Licorice root
Diterpenoids   Coffee
Triterpenoids   Licorice root, hops
Coumarins   Cabbage, peas, spinach, licorice, clover
Acyclics   Hops

For the purposes of this paper, we will concentrate on the isoflavones. Isoflavones have a similar structure to endogenous steroidal sex hormones. They have the ability to bind to estrogen receptors on human cells, and in women, they have a preference for binding to the beta form of the estrogen receptor. As a result of this, they preferentially express estrogenic effects in the central nervous system, blood vessels, bone and skin, and they do so without causing stimulation of the breast or uterus. It is estimated that soy isoflavones are 1/400th to 1/1000th the potency of estradiol. However, in that they are structurally related to endogenous estrogens, they are able to mimic some of the effects of estrogen, but to a significantly less degree. Uniquely, isoflavones may also act as anti-estrogens, much like “Selective Estrogen Receptor Modulators” (SERMs). Isoflavones can be thought of as one of natures’ SERMs. Therapeutically, isoflavones may alleviate menopause symptoms, and lower the incidence of osteoporosis, coronary artery disease, breast and uterine cancer.

Soy Isoflavones

Several studies have now been done on the effect of soy isoflavones on vasomotor symptoms. Most show a benefit, but others do not. Numerous soy isoflavone studies have reported improvement in vasomotor symptoms in menopausal women. Six published studies report improvements with soy protein rich in isoflavones. Four used soy protein or soy foods and two used soy extracts. Criticisms of these studies have been that relatively small numbers of women were studied, most were short term (not more than 12 weeks), the benefit only up to about a 45% reduction, and not all were double-blind clinical trials. In the year 2,000, we began to see publication of studies that were not so promising. A soy product studied in breast cancer patients with hot flashes concluded that the soy did not alleviate hot flashes. Some were on Tamoxifen some were not; (twice as many were on Tamoxifen). Although there was no clear difference in the effect of soy on hot flashes in either group. Patients ranged in age from 18 to over 50. Perhaps the most glaring fault of the study was lack of information about who was postmenopausal versus premenopausal and who had natural menopause, chemotherapy induced menopause, or surgical menopause. A study of breast cancer survivors with hot flashes The most current study on soy isoflavones and vasomotor symptoms reported disappointing results. The most significant difference between the previous studies and this current study is that those six studies were over 12 weeks time or less. This study continued for 24 weeks and symptoms generally declined in all three treatment groups during the first 12 weeks but either increased or showed no change during the last 12 weeks. The important thing to consider here is whether the earlier studies with a seemingly positive outcome in the soy groups were encouraging merely due to a short period of time in the study period. Based on these results, soy isoflavones in the treatment of vasomotor symptoms may not provide the relief we hav e come to hope for. Future studies may need to develop new methods or tools for collecting symptom data that are either more accurate, or extend all studies over at least the 24 weeks.

Other soy studies demonstrate that increasing the soy foods in the diet regulate the menstrual cycle, stabilize bone density, and reduce cholesterol.

Red Clover Isoflavones

Red clover is a member of the legume family and has been used world wide as a source of hay for cattle, horses and sheep and used by humans historically as a source of protein in the leaves and young sprouts. Historically, it has also been recognized as a medicinal plant to humans and more recently as a menopausal herb. The principal substances of red clover include the flavonoid glycosides, coumestans, volatile oils, L-Dopacaffeic acid conjugates, polysaccharides, and some uct_id=442